Barriers to reduce postpartum weight retention in women with Polycystic Ovary Syndrome (PCOS).

Dr Jodie Avery, Senior Research Associate,
The University of Adelaide

Dr Avery’s project was selected as a recipient of the Centre for Research Excellence in PCOS Project Grant awarded recently by the Training Committee.

Dr Jodie Avery, Barriers to reduce postpartum weight retention in women with PCOS

Overview of PCOS

Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women and it generates numerous health problems across the lifespan. PCOS affects up to 18% of women of reproductive age in Australia, and of the women screened for PCOS, 70% have not been diagnosed. PCOS places a great burden on the health care system, and costs in Australia have been extrapolated to ~ $800 million. The aetiology of PCOS is unclear: and both genetic inheritance and lifestyle factors may be implicated. PCOS increases the risk of hyperandrogenism, menstrual disorders, hirsutism, infertility, miscarriage, obesity, insulin resistance, anxiety, depression, cardiovascular complications, endometrial cancer, and type 2 diabetes (T2DM).

During pregnancy, physiological adaptions occur which contribute to gestational weight gain. After pregnancy, post-partum retention of this weight gain contributes to overweight and obesity, which may continue throughout the reproductive years. Postpartum weight gain is a risk factor for worsening reproductive, cardiometabolic and psychological obesity-related morbidity. Optimising post-partum weight loss can reduce future obesity and decrease the risk of future T2DM or CVD and adverse psychological outcomes. This is of great relevance in PCOS given the high associated risk of obesity and associated metabolic and psychological adverse consequences.

The postpartum period is one of great change for all women, and there are barriers that may make weight loss difficult, particularly in women with PCOS, such as urinary incontinence, appetite dysregulation and poor mental health or quality of life. Women with PCOS experience poor quality of life and depression, but the association with weight management and specifically post-partum weight retention is not known. Additionally, incontinence has not been studied in PCOS, and not in the postpartum period. Women with incontinence also have higher levels of depression and lower quality of life, and we have previously found that there is an additive affect, which affects both physical and mental health.

Younger women with incontinence are also less resilient, and this may have implications for weight retention in women with PCOS in the postnatal period. This research focuses on the interaction of PCOS with incontinence risk and psychosocial factors that may influence associated comorbidities such as postpartum obesity, and potentially, T2DM.

The specific aims of this proposal are:

  1. To assess physical, psychosocial and psychological barriers and enablers, for postpartum weight loss in women with and without PCOS, and
  2. To assess the associations between postpartum weight retention, with incontinence and psychosocial and psychological factors in women with PCOS.


The hypotheses which Dr Avery will address in this program of research includes that women with PCOS experience a number of physical and psychological barriers to weight loss and in the post-partum period when compared to women without PCOS.


As part of a larger fellowship application, this project analyses questions from the 2015 South Australia Health Omnibus Survey (HOS). The 2015 SAHOS is including questions regarding PCOS, pregnancy, obesity, health related quality of life (SF-12), mental health, physical activity, risk perception of exercise, diet control and overeating, chronic conditions including T2DM and CVD, health risk factors and a number of demographic factors.

Lifestyle factors in PCOS

Currently, recommended first-line treatment for PCOS is lifestyle change, including healthy eating and optimal physical activity and weight management. We know that obesity exacerbates and weight loss ameliorates some features of PCOS, such as hyperandrogenism, menstrual dysfunction and risk factors for CVD and T2DM.

The postpartum period and PCOS

The efficacy of a healthier lifestyle, particularly concerning weight gain, is a problem in postpartum women at a critical life stage where they may be at high risk of weight retention and weight gain which can contribute to future obesity-related complications such as T2DM and CVD. Even minor gains are associated with increased morbidity and each pregnancy can be associated with further weight gain. This is highly relevant for women with PCOS.

The influence of risk and psychosocial factors on comorbidity in PCOS

Urinary incontinence affects between 18.6 to 60% of postpartum women, and can limit daily tasks, including the ability to exercise, reducing the potential for managing healthy weight after pregnancy. Urinary incontinence also adversely affects health related quality of life and mental health. Women with PCOS are already at risk of adverse mental health and quality of life, and the impact of incontinence on these factors has not been measured in this group, particularly in the context of barriers to weight loss.


The South Australia Health Omnibus Survey (HOS) has investigated a range of health issues annually since 1990. It is a representative population survey using a clustered, self-weighting, systematic, multistage area sample of metropolitan and country areas with populations of more than 1000. Interviews are conducted face-to-face with those aged fifteen years or over.

The nature of an omnibus survey means that a number of not necessarily related questions regarding different topics are included from different users. Over 3000 respondents are interviewed with a response rate of 60%; this means approximately 1500 women will be surveyed. HOS is also an ideal tool to recruit a random sample of women across different age and sociodemographic groups in SA, to be invited to be involved in further research.

Research Plan

Key research strategies include:

  1. Analysis of cross sectional study data surveying healthy weight, overweight and obese women with and without PCOS, regarding the barriers and enablers for weight management including incontinence and other psychosocial and physiological risk factors.
  2. Ethical Implications: The original project methods for the methodology of the SAHOS have been approved by the University of Adelaide Human Research Ethics Committees, and the questionnaire has been approved for 2015. Further quantitative and qualitative work will require appropriate ethics approval from The University of Adelaide before proceeding.
  3. Community Involvement: PCOS support groups will be informed about the project through group internet sites. Results will be conveyed to the community through presentations, media releases, internet sites and newsletters.

Proposed Questions

This project proposes to include five validated questions which have been used in previous SAHOS surveys (1998, 2001) to examine incontinence and reflect the International Continence Society’s definition, in the 2015 SAHOS. These questions will complement other already included questions including the prevalence of PCOS, a measure of pre pregnancy weight, parity and years since pregnancy, present height and weight, the Short Form 12, a measure of physical activity, nutrition, mental health, and other chronic conditions and risk factors, providing great potential for further analysis.


Identification of barriers to weight loss in PCOS will allow the development of targeted strategies to help these high-risk women to achieve optimal postpartum weight loss and lower their risk of obesity and T2DM. The uniqueness of this proposal is the ability to examine a wide range of factors related to PCOS and postpartum health in a community-based sample unlikely the majority of research in PCOS which is conducted in clinic-recruited populations. The novelty of this project is that research concerning barriers and enablers of post-partum weight loss in PCOS women have not been examined. PCOS places a costly burden on the health care system3 and impacts on health and quality of life, yet this has not been examined in relation to the postpartum period as a key life stage to focus weight management to prevent future obesity-related morbidities.

This study builds on the career expertise I have developed in the epidemiological study and qualitative investigation of women’s chronic health conditions and comorbidities. By developing a thorough understanding of this problem, the novel data analysed here will contribute to reducing the burden of PCOS, at both the individual and the population level. This research project aligns with the New Knowledge Program activities of the CRE for PCOS in the following topic areas: Defining the natural history of PCOS; where we are examining the psychological features of PCOS, quality of life, and drivers for adverse psychological health including obesity and infertility, Establishing effective lifestyle and pharmaceutical interventions; and Emotional wellbeing in women with PCOS.

Expected Outcomes

The initiative described here will contribute to composing a high quality dataset, and a local cohort of PCOS women, to enable the analysis of data, further investigations and peer reviewed publications in relevant journals, adding to the evidence base for PCOS, and contributing to the success of future grant applications. A number of manuscripts are already planned as a result of this data collection, including initially ‘The effect of incontinence on weight loss in postpartum women with PCOS’, and ‘The determinants of quality of life in women with PCOS’.  A pool of women with PCOS will also be identified for recruitment purposes for future work (qualitative, cross-sectional or clinical trials). This will provide a basis for further analysis and publication, increasing chances of future funding, and as well as evidence to support fellowship applications.